Best of five
- A. Immediate permanent thyroplasty
- B. Observation without swallow assessment
- C. Laser cordectomy
- D. Temporary injection laryngoplasty with voice and swallow therapy
- E. Contralateral botulinum toxin
FRCS (ORL-HNS) · SECTION 1 SBA
Unilateral vocal-fold paralysis
A professional singer has symptomatic unilateral vocal-fold paralysis two weeks after thyroid surgery. The nerve appeared intact and recovery is possible, but aspiration and severe breathy dysphonia persist. What is the best intervention to discuss?
D. Temporary injection laryngoplasty with voice and swallow therapy
Early reversible medialisation can improve glottic closure while nerve recovery is observed, without committing to permanent framework surgery.
Why every option is right or wrong
A. Immediate permanent thyroplasty: Permanent surgery is usually deferred while meaningful recovery remains possible.
B. Observation without swallow assessment: Aspiration risk and occupational disability need active management.
C. Laser cordectomy: Removing vocal-fold tissue worsens glottic insufficiency.
D. Temporary injection laryngoplasty with voice and swallow therapy: Early reversible medialisation can improve glottic closure while nerve recovery is observed, without committing to permanent framework surgery.
E. Contralateral botulinum toxin: This does not restore closure and may worsen airway/voice function.
What if the scenario changed?
If paralysis remained stable without recovery after an appropriate interval, permanent framework surgery or reinnervation could be considered.
Independent Clinora preparation material; not official JCIE content, an accredited programme or a substitute for local policy and specialist judgement.
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